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Comparative Study
. 2025 May 16;20(1):470.
doi: 10.1186/s13018-025-05842-9.

Three-column osteotomy versus Halo-gravity traction combined with posterior column osteotomy in the treatment of dystrophic neurofibromatosis type 1 kyphoscoliosis: a retrospective comparative cohort study

Yuan-Shun Lo #  1   2   3 , Yu-Tong Dai #  4 , Yong Qiu  4 , Erh-Ti Ernest Lin  2 , Hung-Lun Hsieh  1 , Xue-Peng Wei  5 , Chun-Hao Tsai  2 , Yi-Chin Fong  1   2 , Hsien-Te Chen  2   3 , Shiau-Tzu Tzeng  6 , Ben-Long Shi  7   8
Affiliations
Comparative Study

Three-column osteotomy versus Halo-gravity traction combined with posterior column osteotomy in the treatment of dystrophic neurofibromatosis type 1 kyphoscoliosis: a retrospective comparative cohort study

Yuan-Shun Lo et al. J Orthop Surg Res. .

Abstract

Background: Dystrophic neurofibromatosis type I (NF1) kyphoscoliosis presents unique challenges for corrective spinal surgery due to anatomical abnormalities. To compare the radiographic and clinical outcomes of dystrophic neurofibromatosis type 1 (NF1) kyphoscoliosis patients undergoing three-column osteotomy (3CO), halo-gravity traction (HGT), or posterior column osteotomy (PCO) and to evaluate their efficacy and safety in this cohort, different treatment strategies and their associated complication rates warrant further comprehensive investigation.

Methods: Dystrophic NF1 kyphoscoliosis were divided into 3CO, HGT, and PCO groups based on the surgical strategy. Radiographic parameters were measured preoperatively, postoperatively, and at each follow-up. Intraoperative and postoperative complications were recorded for each patient, and patient-reported outcomes were assessed using the Scoliosis Research Society-22 (SRS-22) questionnaire. Differences among the three groups were analyzed.

Results: A total of 9 patients were included in the 3CO, 22 in HGT group, 95 in PCO groups, respectively. Significant differences among the three groups were found in terms of operation time (p = 0.011), estimated blood loss (p = 0.003), and number of satellite rod techniques (p = 0.013). At pre-operation, the Cobb angles of main curves were 84.3 ± 24.6° in 3CO group, 99.1 ± 24.3° in HGT group, 60.0 ± 16.8° in PCO group. At post-operation, significant post-operative improvements were found in the Cobb angles of the main curves, apical vertebral translation (AVT), segmental kyphosis (SK), and deformity angular ratio (DAR) in all three groups (p < 0.001). No significant correction loss was observed during the follow-up. Six complications were found in the 3CO group, 13 in the HGT group, and 40 in the PCO group.

Conclusions: PCO, 3CO, and HGT could be applied to dystrophic NF1 patients. The 3CO is also associated with increased perioperative complications.

Level of evidence: IV.

Keywords: Halo-gravity traction; Kyphoscoliosis; Neurofibromatosis type 1; Posterior column osteotomy; Three-column osteotomy.

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Conflict of interest statement

Declarations. Ethics approval and consent for publication: For underage participants, informed consent was obtained through legal guardians, who signed on their behalf and ensured that the participants were adequately informed and fully understood the nature of the study. Written consent was obtained from all study participants, and approval was obtained from the Institutional Review Board of China Medical University Hospital (CMUH114-REC1-34256). Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A 13-year-old female with dystrophic NF-1 kyphoscoliosis underwent T10/11 VCR + PSF, reducing Cobb angle from 140° to 70°, SK from 130° to 50°, DAR from 47° to 26° per level. Despite an incidental dural tear, no correction loss was observed at the 2-year follow-up
Fig. 2
Fig. 2
A 17-year-old male with dystrophic NF-1 kyphoscoliosis underwent HGT followed by PCO + PSF, reducing Cobb angle from 133° to 90°, SK from 105° to 35°, DAR from 44° to 28° per level. At the 2-year follow-up, no correction loss or complications were observed
See this image and copyright information in PMC

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